Abstract
BackgroundThe Republic of Niger has the highest rate of early marriage and adolescent fertility in the world. Recent global health initiatives, such as Family Planning 2020, have reinvigorated investments in family planning in low- and middle-income countries (LMICs). As part of this initiative, Niger has implemented ambitious plans to increase contraceptive prevalence through policies designed to increase coverage and access to family planning services. One strategy involves the deployment of volunteer community health workers (relais communautaires) in rural settings to improve access to family planning services, especially among adolescents and youth. The objective of this article is to determine if visits by relais are associated with increased use of modern contraception among young married women in rural Niger.MethodsCross-sectional data from a household survey were collected from young married women between the ages of 13 and 19 in three rural districts in the region of Dosso, Niger from May to August 2016. Multivariate logistic regression was conducted to assess the odds of married female youth reporting current use of modern contraceptive methods based on being visited by a relais in the past three months.ResultsA total of 956 young married women were included in the final analysis. Among study participants, 9.3% reported a relais visit to discuss health issues in the past three months and 11.4% reported currently using a modern method of contraception. Controlling for socio-demographic variables, the odds of current use of modern contraceptive methods were higher among young married women who were visited by a relais in the last three months compared to those not visited by a relais during this period (AOR = 1.94[95% CI 1.07–3.51]). In this study setting, relais were less likely to visit nulliparous women and women that worked in the past 12 months.ConclusionYoung married women visited by relais were more likely to use modern contraceptive methods compared to those not visited by a relais. These results are consistent with similar family planning studies from sub-Saharan Africa and suggest that relais in Niger may be able to provide access to essential family planning services in rural and hard-to-reach areas. Additional efforts to understand the contraceptive barriers faced by nulliparous women and working women should be a key research priority in Niger.Trial registrationClinical trial registration number 2016–1430; registered on October 7, 2016 (retrospectively registered).
Highlights
The Republic of Niger has the highest rate of early marriage and adolescent fertility in the world
Plain English summary The West African nation of Niger has low family planning use, high rates of early marriage, and most of its population lives in rural areas—where there are fewer accessible health resources
Women who worked outside of their house in the last 12 months were found to be less likely to use family planning. These findings suggest that relais contribute positively to access to and uptake of essential family planning services in Niger’s Dosso region but that further investigation is required to understand the challenges faced by young women without children and those that work when seeking family planning services
Summary
The Republic of Niger has the highest rate of early marriage and adolescent fertility in the world. Recent global health initiatives, such as Family Planning 2020, have reinvigorated investments in family planning in low- and middle-income countries (LMICs). As part of this initiative, Niger has implemented ambitious plans to increase contraceptive prevalence through policies designed to increase coverage and access to family planning services. In 2014, approximately 225 million women of reproductive age in developing countries had an unmet need for modern contraception, many of them living in rural and hard-to-reach areas with limited access to high-quality health services [1,2,3]. While there have been important successes, such as a global increase in contraceptive use among married women, family planning investments and access still fall short in many low- and middle-income countries (LMICs)
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